Older home care clients’ agency manifests as resistance and adaptation

Older home care clients perceive themselves as capable individuals who can cope despite having daily needs for help and assistance, but this is something social and healthcare professionals do not always recognise, a recent study from the University of Eastern Finland shows. The study examined experiences of agency among older home care clients. Maintaining agency in daily life supports older individuals’ well-being and meaningful life at home.

The study was conducted as part of the Old-age Social Exclusion in Home Care – Prevalence, Meanings & Intervention project, SOLDEX. For the study, researchers interviewed 20 home care clients aged 73–99, identifying three forms of agency, i.e., resistant, adaptive and supported agency.

“There was some overlap between these different forms of agency. However, older individuals’ efforts to be in control of their life were evident in all of them,” Senior Researcher Marjo Ring of the University of Eastern Finland says.

In resistant agency, the older individual resists the changes arising from their need for assistance and home care, and strives to maintain their lifestyle, even if it conflicts with the practices and methods considered important by home care workers.

“A practical example of this would be a situation where the older individual reduced the number of visits by home care workers despite obviously needing assistance,” Ring explains.

In adaptive agency, the older individual accepts that they need assistance due to declining functional capacity and adjusts their personal expectations to the prevailing situation, thus striving to maintain active control over their daily life.

“For example, with increasing needs for assistance, the older individual may change and lower their previous goals so that they can continue living at home, supported by home care. They may also decide to not leave their home to meet friends or run errands because it would require asking other people for help and instead, they keep in touch with friends by phone.”

In supported agency, the older individual relies on the assistance of friends and relatives to achieve important goals in their daily life. Such support for agency was not expected from home care workers but was seen as being specifically dependent on informal assistance.

The study shows that older individuals’ agency does not disappear with increasing needs for assistance but changes and adapts to new requirements and life situations. Interviews with home care clients show that they wish to be seen as individuals with their unique life histories, values and desires to live a life of their own despite increasing needs for assistance.

According to the researchers, it is important for home care workers to recognise and support their clients’ agency, as this contributes to better consideration of older individuals’ opinions of how their services should be provided and strengthens perceived life control and self-determination among those in need of care.